Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome and adolescent chronic fatigue.
Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome and adolescent chronic fatigue.
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直立不耐受的模式：直立性心动过速综合征和青少年慢性疲劳。
DOI：
10.1016/s0022-3476(99)70025-9
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Munoz,J
中科院分区：
文献类型：
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作者：
Stewart,JM;Gewitz,MH;Weldon,A;Munoz,J
目的探讨青少年直立性心动过速综合征（OTS）与慢性疲劳综合征（CFS）的异同点，以及直立性不耐受在头高位倾斜（HUT）时的表现形式。研究设计采用心电图和动脉血压测量法，对20例OTS青少年HUT时的心率和血压反应进行了研究，并与25例CFS青少年、13例健康对照组进行了比较。结果对照组13例中4例出现典型的血管迷走神经性晕厥，血压和心率突然下降，20例单纯性晕厥患者中14例出现类似的HUT反应。所有CFS患者（25/25）均出现严重直立性症状，其中2/25例发生晕厥，16/23例（13/16例发生晕厥）发生HUT时的早期直立性心动过速，7/23例（6/7例发生晕厥）发生迟发性直立性心动过速。25例中18例出现手足发绀和水肿。20例OTS患者中有10例出现早期直立性心动过速。其中9/10例为水肿，但4/9例为迟发性低血压。20例中10例发生迟发性心动过速（均为心动过速）。CFS患者以肢端发绀、水肿多见，OTS患者较少见，仅1例出现单纯性晕厥。直立性症状相似，但更严重的CFS患者与OTS.ConclusionsSymptoms和模式的直立性心率和血压的变化OTS重叠强烈与CFS。OTS患者的立位不耐受可能是慢性疲劳病理生理学的一种弱化形式。（J Pediatr 1999;135：218-25）
ObjectivesTo describe the orthostatic tachycardia syndrome (OTS) in adolescents, similarities to and differences from chronic fatigue syndrome (CFS), and patterns of orthostatic intolerance during head-up tilt (HUT).Study designUsing electrocardiography and arterial tonometry, we investigated the heart rate and blood pressure responses during HUT in 20 adolescents with OTS compared with 25 adolescents with CFS, 13 healthy control subjects, and 20 patients with simple faint.ResultsOf the control subjects, 4 of 13 experienced typical vasovagal faints with an abrupt fall in blood pressure and heart rate, and 14 of 20 patients with simple faint experienced similar HUT responses. All patients with CFS (25/25) experienced severe orthostatic symptoms with syncope in 2 of 25, early orthostatic tachycardia during HUT in 16 of 23 (13/16 hypotensive), and delayed orthostatic tachycardia in 7 of 23 (6/7 hypotensive). Acrocyanosis and edema occurred in 18 of 25. Early orthostatic tachycardia occurred in 10 of 20 patients with OTS. Of these, 9 of 10 were hypotensive, but hypotension was delayed in 4 of 9. Delayed tachycardia occurred in 10 of 20 (all hypotensive). Acrocyanosis and edema occurred in most patients with CFS, fewer patients with OTS, and in one patient with simple faint. Orthostatic symptoms were similar but more severe in patients with CFS compared with patients with OTS.ConclusionsSymptoms and patterns of orthostatic heart rate and blood pressure change in OTS overlap strongly with those of CFS. Orthostatic intolerance in OTS may represent an attenuated form of chronic fatigue pathophysiology. (J Pediatr 1999;135:218-25)